Laparoscopic Near-Total Pancreatectomy for Persistent Hyperinsulinemic Hypoglycemia of Infancy: Report of Two Cases

Near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia (PHH) of infancy has been done, so far, only by open surgery, and the application of laparoscopic techniques for this procedure has not been documented. In this article, we report 2 cases of successful laparoscopic near-total pancreatectomy for PHH. Two infants underwent surgery at the age of 60 and 54 days and at body weights of 7700 and 5700 g, respectively. Four ports were used for the patient 1 and three ports plus fixation sutures of the stomach to the abdominal wall for stomach traction were used for patient 2. The pancreas was dissected free from the spleen and splenic vessels and was mobilized beyond the right side of the superior mesenteric vein. The head of the pancreas was transected by using the Harmonic Scalpel (Tokyo, Japan), leaving only 1 cm of the pancreas along the duodenal C-loop. The operative times were 180 and 160 minutes. There was neither an intra-nor a postoperative abdominal complication. Oral feeding was resumed on the postoperative day 1. The blood glucose level increased immediately after the operation. Follow-up period of 12 months showed normal levels of blood sugar and insulin for both patients. Laparoscopic near-total pancreatectomy can be a safe, effective procedure for small infants with PHH.